Join us for an in-depth session on the basics of ECG interpretation with Dr. Hasna Mohammad Ian and Dr. Shan Ras Wen. This crucial skill would be greatly beneficial for foundation level practitioners and final year medical students. We'll break it down into a six-step approach to ensure accuracy and set you up to catch critical findings in patient evaluations. In addition to the methodical approach to understanding ECGs, we will also analyze two case scenarios for a comprehensive grasp of this fundamental clinical skill. Expect discussions revolving around rhythm, heart rates, QR S complexes, and cardiac axis. Walk away from our session with a solid understanding of ECG interpretation.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Hello, everyone. Um Thank you for joining our E CG um basics of E CG Talk B from the Aspire Med Ed team. Can you all hear me? You can just drop a yes or no in the chart? Ok. Yeah, that's great. You can hear me. Um And can you all see my presentation? All right. Um So today will be, it's uh I'm Hasna Mohammad Ian, one of the fy two doctors uh working at Dudley Group NHS Trust and um my colleague Shan Ras Wen. Um it will also be um core today. Um We'll be going through the basics of ECG what we think is important to look for when you look at an ECG at a foundation level or um final year medical students, we'll find this useful as well. Um And we'll go through two cases and how to interpret it. Everyone. Happy to start. Ok, then let's um try and see if this will change. So we'll have a six step approach to interpreting an ECG. So I'll go through all the six steps which I have um I think is important and like I've um tried some ways to kind of make help you all um interpret. So I think this is really important to have a structure. So you go um step by step. If you follow the steps, you are very unlikely to miss any important findings. And then after I go through the six steps, my colleague will go through the um cases with you all. So the six tabs that we look. So when you get an ECG, the things that you look for, II generally would like to go through the six tabs first checking the rhythm and then the rate looking at the QR S complexes, look at the axis and then pay attention to the intervals, specifically the um pr and the QT intervals and the ST segment and then I'll go through each of the steps in detail. Now, so first thing you want to check the rhythm when you're checking the rhythm, you want to make sure there are P waves, there are P waves before every QR S complexes. And you want to check if the, so if there is AP wave, that means it is a sinus rhythm. If the P waves are not there, then it's some sort of non sinus rhythm and the um electrical activity is starting somewhere else in the heart. Um So P tells you the atria is depolarizing. So that's um that just um shows the atrial depolarization and usually um it is um three small squares or 0.12 seconds. Um long um the P waves and if you look at the first rhythm here, it has a, I don't know if you are, if you can see my cursor there, um It has ap wave before every um QR S complex. And you can see that the QR S complexes um are equal distance apart uh along the rhythm strip. So this is a regular sinus rhythm. And then in the second strip, you can see that you have um P waves before some of the complexes and, but there are also like ectopics. So these are called, this is a regularly irregular rhythm and um it's called ventricular bi gemini because of the ventricular ectopics that are happening just um after every um sort of um proper um conduction. And then the last strip you have is an irregularly irregular rhythm. You can see this is af which there is no pattern to um how the RS complexes are repeating and you can't clearly see AP wave, it's um of squiggly line basically. Um So it's af and um it is irregularly irregular rhythm. So this is the first part of looking at the ECG you, once you've identified what rhythm that your patient is in, you'll go on to finding out the rate. So you want to find out whether they are tachycardic, bradycardic or if the heart rate is normal. So there are two ways to, there are a few other way, a few ways um to calculate the rhythm. Um However, I like to go by this um dividing the um number of complexes uh or the number of um boxes within the, between the two QR s complexes by um dividing 300 by the number of squares. So it gives you an approximate um heart rate. So this is basically rate is just how rate will tell you how many times the heart is beating in a minute. So if the rhythm is regular, you just go ahead, count the number of big squares with, between your QR S complexes and then um divide 300 by it and then you'll get your rate. And then if you have an irregular rhythm, of course, it's gonna be difficult because the number of blood squares between the QR S complexes are going to be different. Um So you will not be able to use the same uh formula on it. So, the easiest way to do is if you get a rhythm strip, it's usually 10 seconds long. And then you um count the number of complexes in a 12th strip and then you multiply it by six to get a, get an average or um an approximate um rate for your um heart rate in an irregular rhythm. And then we'll move on to QR S complexes. Then this the next stage is to find the cure as complexes. If the QR S complex is, um you have to pay attention to how broad they are normally a QR s complex is less than 0.12 seconds. So it should be less uh less than, or um three small squares. Um If it is within this normal limit, that means the bundle of his is intact and the electrical impulses are flowing through the right um pathway if they are longer than this three small squares length, um That means there is some sort of pro problem with the bundle of his and the electrical conduction is going in an alternative route. Um You see narrow QRS complexes in sinus rhythm or atrial flutter. You can see on the side, the so tooth appearance on this left sided ecg strip where you can see it is an atrial flutter rhythm and then you see broad QR S is in lots of different um conditions. Um like um hyperkalemia, you could have wolf Parkinson white bundle branch block is also uh will also have um broad QR S complex ventricular tachycardias will have broad QR S complexes. Now, with the bundle branch block, the usual um very commonly used technique is William and marrow. So you look at the V one and V six leads if the QR S complex in V one is W shaped. So uh it's negative deflection and then the V six lead, it is an M shaped QR S complex. You say that it's a left bundle branch block, you can be sure that it's a left bundle branch block. And then if the V one is an M shaped and the V six is a W shaped um QR S complex, then it is a right bundle branch block uh with the left bundle branch block. The thing is um you have to make sure when you are also interpreting the ST segment, you have to make sure that the patient doesn't have left bundle branch block in there. Because if there is left already co existing left bundle branch block, it will make your um ST segment interpretation a bit difficult. And um you have to use these carbos um criteria um which we can go away in another session because it's a bit of a um longer one, we won't be able to cover it within the time limit. Now, the fourth step is to look at um the axis of the um cardiac axis on the ECG. So I just um come up with this technique using the thumbs because it helps me remember uh it easily and some people um remember it in a way when they interpret it on the ECG um paper, when the um QR S complexes are moving away or facing towards each other. There are so many different techniques to um identify the axis, uh cardiac axis. What I found easy was to remember using lead ones and twos um which is commonly used. So I use my left hand as a lead two and right hand as a lead one to look at the QR S complexes. So if the QR S complexes are positive, then I would put a thumbs up and if the QR S complexes are negative, then it's a thumbs down. So if both.
